Scenario D

Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Rosblane. Residents are outraged and worried. There have already been 27 deaths.

The cause of the outbreak appears to be Campylobacter jejuni. (Please refer to the WHO Campylobacter Fact Sheet for more information about the pathogen.)

Scanning electron microscopy (SEM) image of Campylobacter jejuni cells. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=5778)

Figure 1: Scanning electron microscopy (SEM) image of Campylobacter jejuni cells. Image credit: CDC

Each member of your group will play one of the following roles as you attempt to tackle the disease outbreak and save your city:

  1. Provost (head of the city council)
  2. Representative from a national public health org. (Public Health Scotland)
  3. Epidemiologist (on secondment from Public Health Scotland)
  4. Director of the city’s main hospital (North Shore)
  5. City planner/civil servant
  6. Microbiologist (working in one of the NHS Scotland clinical labs)
  7. Public communications expert (past and current sci comm campaigns)
  8. Doctor at a major surgery in Rosblane

You must work together, using the information that has been provided for you in the attached information packets, and decide what action(s) should be taken to control the measles outbreak currently plaguing your city, Rosblane. Your actions should be evidence-based – use the peer-reviewed literature to decide on measures that will stop the pandemic in your scenario.

Your action points may include directives to gather more information (e.g., contact tracing of current cases, microbiological testing of food/water, etc.), or specific directives (e.g. public health measures, non-pharmaceutical interventions, etc.). Use the data/expertise of all group members. Be clear, concise, and specific.

You should submit 3-5 specific actions to control the pandemic, using the workshop 3 pro forma (available on MyPlace). Submit this by noon, Friday March 10th, via the submission link on MyPlace.

Information Packet D1

You are the provost of Rosblane, elected in 2016.

Photograph of Rosblane city centre. Image credit: DALL-E

Figure 2: Photograph of Rosblane city centre. Image credit: DALL-E

The current population of Rosblane (as of December 2022) is 167799. The demographic data for the city is shown below.

Rosblane demographics (Source: Office for National Statistics)Rosblane demographics (Source: Office for National Statistics)

Figure 3: Rosblane demographics (Source: Office for National Statistics)

You were elected as a member of the popular “Peace and Prosperity” party and made a number of election promises regarding a “Green New Deal” for Rosblane.

Voting intention by Rosblane residents (Source: YouGov polling)

Figure 4: Voting intention by Rosblane residents (Source: YouGov polling)

There are currently 38 elected councillors, representing the 5 main political parties in Rosblane as follows:

Political Party Number of Seats
New Hope 3
Wind and Solar Power 8
Peace and Prosperity 17
Rational Industry 8
Social Unity 2



The overall budget (expenditures) for the 2021-2022 financial year is £510082879. A summary of expeditures by category for this financial year is shown below.

Public expenditures by category for the 2021-2022 financial year (Source: Rosblane City Council)

Figure 5: Public expenditures by category for the 2021-2022 financial year (Source: Rosblane City Council)

Your office has recently received a great deal of correspondence regarding the pandemic in Rosblane. A representative sample of these e-mails is shown below.

From:
To:
Cc: Subject: This Disgraceful Pandemic

Dear Provost,

I am devastated to hear about this new pandemic in Rosblane. There seems to be no end to the suffering that pandemics inflict on our city in these days.

I wish that your office is going to do something about horrible pandemic very soon.

Yours truly,
Roman

From:
To:
Cc:
Subject: Pandemic Disaster for Businesses

Dear Provost,

This new pandemic in Rosblane has the potential to ruin our businesses. I run a records shop on the high street and practically went out of business due to COVID.

Businesses must be free to operate, not prosecuted by some nanny state.

I expect that your office is going to do something about tragedy immediately, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford face masks and gallons of hand sanitizer.

Yours sincerely,
Siobhan (Around the Corner, proprietor)

From:
To:
Cc:
Subject: Government Overreach

Dear Provost,

I dread that you and your office are going to use this new pandemic as yet another excuse for government overreach into citizens’ lives. The mental health consequences of the last pandemic were underappreciated, but very real - people suffered due to the lockdowns and children’s development was affected by the wearing of face masks and the closing of schools.

I hope that you will do the right thing in this time of crisis and that I will be able to vote for you again in the coming elections with a clean conscience.

Respectfully,
Anika (a concerned voter)

From:
To:
Cc:
Subject:

Dear Provost,

I have just learned that my my nana has passed away due to the new pandemic in Rosblane. You cannot begin to imagine the grief that we are feeling.

Words cannot begin to describe our loss.

I really wish that our government had better learned its lessons from the COVID-19 pandemic and could have prevented this terrible tragedy.

All the best,
Su

As Provost of Rosblane, you are of course familiar with the work of the Standing Committee on Pandemic Preparedness, the UK Pandemic Preparedness plan, and the latest COVID-19 health protection guidance released by Public Health Scotland.

Information Packet D2

You are a representative from Public Health Scotland, sent to Rosblane to help with the Campylobacter jejuni outbreak.

Your briefing packet includes the following documents:

Campylobacter guidance, data and surveillance (PHS)

Campylobacter Food Poisoning (Food Standards Scotland)

Campylobacter: Estimating the burden of gastrointestinal infection in Scotland using data linkage

Bessell, Paul R et al. “Geographic determinants of reported human Campylobacter infections in Scotland.” BMC public health vol. 10 423. 15 Jul. 2010, doi:10.1186/1471-2458-10-423

Information Packet D3

You are an epidemiologist working for Public Health Scotland, sent to Rosblane to help with the measles outbreak.

A team of scientists working together have in a PHS lab have isolated and cultured Campylobacter jejuni (following standard procedures) from a number of patient samples taken during this outbreak; isolated Campylobacter jejuni DNA from these cultures; sequenced this DNA using an Illumina MiSeq platform; assembled the short paired-end reads; and compared these assemblies to the extant Campylobacter jejuni sequences available in the NCBI databases. The results of these experiments are summarised in the table below.

Patient NCBI accession of closest database match
1 GCA_001686905.1
2 GCA_001299565.1
3 GCA_001686905.1
4 GCA_001686905.1
5 GCA_000835285.1
6 GCA_000835285.1
7 GCA_000835285.1
8 GCA_000835285.1
9 GCA_000835285.1
10 GCA_000835285.1



Your briefing packet also includes the following documents:

Campylobacter jejuni/coli pubMLST

Bessell, Paul R et al. “Using sequence data to identify alternative routes and risk of infection: a case-study of campylobacter in Scotland.” BMC infectious diseases vol. 12 80. 1 Apr. 2012, doi:10.1186/1471-2334-12-80

Information Packet D4

You are the director of Rosblane’s main hospital, the North Shore, which has 550 beds across 9 different wards and 10 operating theatres.

The North Shore hospital in Rosblane. Image credit: [DALL-E

Figure 6: The North Shore hospital in Rosblane. Image credit: [DALL-E

The annual operating budget for financial year 2021-2022 was £1.5 million, and average expenditures are shown by category in the figure below.

Hospital expenditures by category for financial year 2021-2022 (Source: NHS Scotland)

Figure 7: Hospital expenditures by category for financial year 2021-2022 (Source: NHS Scotland)

The North Shore has units specialising in coronary care; maternity care; dermatology; gastroenterology; an ear, nose, and throat clinic; an eye clinic; and an orthopedic unit.

There are currently 25 ICU beds (with ventilators) available, an increase from the 14 ICU beds in the North Shore in November 2019. Average ICU bed occupancy before and during the COVID-19 pandemic is in the figure below.

ICU bed occupancy for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 8: ICU bed occupancy for the Rosblane North Shore hospital (Source: NHS Scotland)

There are approximately 1.3m admissions to the North Shore hospital annually, the majority of these being to the emergency (A&E) department.

Admissions to the Rosblane North Shore hospital by category (Source: NHS Scotland)

Figure 9: Admissions to the Rosblane North Shore hospital by category (Source: NHS Scotland)

A&E waiting times have been called “disastrously high” in recent months, both by the press and by tthe hospital ombudsman.

ICU waiting times for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 10: ICU waiting times for the Rosblane North Shore hospital (Source: NHS Scotland)

The North Shore has been set a goal of 25% reduction in sepsis mortality (compared to past years)and 50% reduction in the nosocomial transmission of superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridiodes difficile (C. diff), and Candida auris (C. auris).

Key Performance Indicators (KPIs) related to infectious diseases for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 11: Key Performance Indicators (KPIs) related to infectious diseases for the Rosblane North Shore hospital (Source: NHS Scotland)

There are currently 175 patients in the North Shore with confirmed or suspected Campylobacter jejuni, with 15 of these patients currently in the ICU.

The hospital follows the guidelines set out in the National Infection Prevention and Control Manual.

As a hospital director, you are familiar with the literature surrounding hospital pandemic preparedness, and regularly read papers such as:

Mer, Mervyn et al. “Critical Care Pandemic Preparation: Considerations and Lessons Learned from COVID-19.” Critical care clinics vol. 38,4 (2022): 761-774.

Tacconelli, Evelina et al. “Challenges of data sharing in European Covid-19 projects: A learning opportunity for advancing pandemic preparedness and response.” The Lancet regional health. Europe vol. 21 (2022): 100467.

Adelaja, I., Sayma, M., Walton, H., McLachlan, G., de Boisanger, J., Bartlett-Pestell, S., Roche, E., Gandhi, V., Wilson, G. J., Brookes, Z., Yeen Fung, C., Macfarlane, H., Navaratnam, A., James, C., Scolding, P., & Sara, H. (2020). A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience. Future healthcare journal, 7(2), 165–168.

Information Packet D5

You are a civil servant working in Rosblane, working closely with the provost, city council and various agencies including the NHS, the UK Health Security Agency (UKHSA), and the Scottish Environment Protection Agency (SEPA).

Some of the key Rosblane facts and figures at a glance are summarized in the table below.

Community Amenities Details
Schools 5 primary schools, 4 secondary schools, 1 college
Care Homes 5, each with ~50 bed capacity
Restaurants and Cafes 68
Parks and Playgrounds 8
Economic Indicators Details
GDP/capita £43078
Unemployment Rate 5%
Traffic and Transport Details
Traffic fatalities (average/month) 18



Your briefing packet on Campylobacter jejuni includes the following information.

Campylobacter information and guidance (Food standards Scotland)

Campylobacter “Fit for Travel” advice

MacRitchie, L A et al. “Consumer acceptability of interventions to reduce Campylobacter in the poultry food chain.” Food control vol. 35,1 (2014): 260-266. doi:10.1016/j.foodcont.2013.06.005

Bessell, Paul R et al. “Geographic determinants of reported human Campylobacter infections in Scotland.” BMC public health vol. 10 423. 15 Jul. 2010, doi:10.1186/1471-2458-10-423

Scott, Elizabeth. “Food safety and foodborne disease in 21st century homes.” The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses vol. 14,5 (2003): 277-80.

Information Packet D6

You are a microbiologist working in the microbiology department at the Greater Rosblane Clinical Laboratory. Your laboratory is equipped to handle a range of culture samples (including anaerobic and microaerobic bacteria, as well as viruses), and you routinely process1758 samples monthly.

You are familiar with the culture requirements for growth of Campylobacter, and the UK Standards for Microbiology Investigations (UK SMI) for Identification of Campylobacter species.

Campylobacter jejuni grown on Skirrow and Butzler growth medium. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=15986)

Figure 12: Campylobacter jejuni grown on Skirrow and Butzler growth medium. Image credit: CDC

LaGier, Michael J et al. “A real-time multiplexed PCR assay for rapid detection and differentiation of Campylobacter jejuni and Campylobacter coli.” Molecular and cellular probes vol. 18,4 (2004): 275-82.

Ferrari, Sevinc et al. “Validation of PCR methods for confirmation and species identification of thermotolerant Campylobacter as part of EN ISO 10272 - Microbiology of the food chain - Horizontal method for detection and enumeration of Campylobacter spp.” International journal of food microbiology vol. 388 (2023): 110064.

Ojima-Kato, Teruyo et al. “Proteotyping of Campylobacter jejuni by MALDI-TOF MS and Strain Solution Version 2 Software.” Microorganisms vol. 11,1 202. 12 Jan. 2023, doi:10.3390/microorganisms11010202

Hong, Seung-Hwan et al. “Gold Nanoparticle and Polymerase Chain Reaction (PCR)-Based Colorimetric Assay for the Identification of Campylobacter spp. in Chicken Carcass.” Food science of animal resources vol. 43,1 (2023): 73-84. doi:10.5851/kosfa.2022.e59

Information Packet D7

You are a public communications expert, often employed by the Rosblane city council to manage the PR response to different initiatives or crises.

As a public communications expert, you are familiar with the literature surrounding science communication in a pandemic, including papers such as:

Matta, G. Science communication as a preventative tool in the COVID19 pandemic. Humanit Soc Sci Commun 7, 159 (2020).

Abdool Karim, Salim S. “Public understanding of science: Communicating in the midst of a pandemic.” Public understanding of science (Bristol, England) vol. 31,3 (2022): 282-287.

Royan, Regina et al. “Use of Twitter Amplifiers by Medical Professionals to Combat Misinformation During the COVID-19 Pandemic.” Journal of medical Internet research vol. 24,7 e38324. 22 Jul. 2022, doi:10.2196/38324

Tait, Margaret E et al. “Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S.” Preventive medicine reports vol. 29 (2022): 101971.

You have assembled the following information/resources for this meeting:

World Food Safety Day Campaign Materials

Campylobacter campaign partner toolkit

Gölz, Greta et al. “Relevance of Campylobacter to public health–the need for a One Health approach.” International journal of medical microbiology : IJMM vol. 304,7 (2014): 817-23.

Information Packet D8

You are one of the doctors at the largest surgery in Rosblane. In the past fortnight, 100 of your patients have recently presented to the surgery with symptoms consistent with Campylobacter jejuni. You have therefore recently been familiarising yourself with the relevant literature:

Campylobacter Information for Health Professionals (CDC)

BMJ Best Practice - Campylobacter Infection

NICE Gastroenteritis Background Information

NICE Gastroenteritis: Management

Tang, Yizhi et al. “Antibiotic resistance trends and mechanisms in the foodborne pathogen, Campylobacter.” Animal health research reviews vol. 18,2 (2017): 87-98.

Valenčak-Ignjatić, Ivana et al. “Campylobacter jejuni subdural hygroma infection in a 2-year old boy: case report and a brief literature review.” BMC infectious diseases vol. 22,1 700. 20 Aug. 2022, doi:10.1186/s12879-022-07680-0

Lévesque, Simon et al. “Campylobacteriosis in urban versus rural areas: a case-case study integrated with molecular typing to validate risk factors and to attribute sources of infection.” PloS one vol. 8,12 e83731. 26 Dec. 2013, doi:10.1371/journal.pone.0083731

Information Packet D9